Laparoscopic Diagnosis and Management of Bilateral Uterine Remnants

Introduction: Müllerian anomaly is a result of abnormal elongation, fusion, canalization, or resorption of the paramesonephric ducts during organogenesis. An accurate diagnosis and appropriate treatment planning can be facilitated by imaging modalities; however, direct visualization of the pelvic organs may be necessary for an accurate diagnosis. Case Description: A 14-year-old girl with primary amenorrhea presented with severe abdominal pain. Magnetic resonance imaging suggested a unicornuate uterus on the right side with a left-sided noncommunicating uterine horn, both with functional endometrium and likely high outflow obstruction. She was counseled on removal of the noncommunicating uterine horn and correction of the outflow obstruction; however, on laparoscopic and vaginoscopic exploration, she was found to have bilateral noncommunicating functional uterine remnants with a normal-length vagina and a septate hymen. She underwent laparoscopic removal of uterine remnants with complete symptom resolution. Discussion: Preoperative imaging studies can help guide patient counseling and preoperative planning in cases of suspected müllerian anomaly; however, the final diagnosis may not be made until the time of surgery. The patient should be prepared for multiple possibilities during preoperative consultation.